Abstract
BackgroundPrevious studies have shown positive association between HIV-related stigma and depression, suicidal ideation, and suicidal attempt among people living with HIV/AIDS (PLWH). But few studies have examined the mechanisms among HIV-related stigma, depression, and suicidal status (suicidal ideation and/or suicidal attempt) in PLWH. The current study examined the relationships among perceived and internalized stigma (PIS), depression, and suicidal status among PLWH in Guangzhou, China using structural equation modeling.MethodsCross-sectional study by convenience sampling was conducted and 411 PLWH were recruited from the Number Eight People’s Hospital from March to June, 2013 in Guangzhou, China. Participants were interviewed on their PIS, depressive symptoms, suicidal status, and socio-demographic characteristics. PLWH who had had suicidal ideation and suicidal attempts since HIV diagnosis were considered to be suicidal. Structural equation model was performed to examine the direct and indirect associations of PIS and suicidal status. Indicators to evaluate goodness of fit of the structural equation model included Chi-square Statistic, Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Square Residual (SRMR), and Weighted Root Mean Square Residual (WRMR).ResultsMore than one-third (38.4%) of the PLWH had depressive symptoms and 32.4% reported suicidal ideation and/or attempt since HIV diagnosis. The global model showed good model fit (Chi-square value = 34.42, CFI = 0.98, RMSEA = 0.03, WRMR = 0.73). Structural equation model revealed that direct pathway of PIS on suicidal status was significant (standardized pathway coefficient = 0.21), and indirect pathway of PIS on suicidal status via depression was also significant (standardized pathway coefficient = 0.24). There was a partial mediating effect of depression in the association between PIS and suicidal status.ConclusionsOur findings suggest that PIS is associated with increased depression and the likelihood of suicidal status. Depression is in turn positively associated with suicidal status and plays a mediating role between PIS and suicidal status. Therefore, to reduce suicidal ideation and attempt in PLWH, targeted interventions to reduce PIS and improve mental health status of PLWH are warranted.
Highlights
Previous studies have shown positive association between Human immunodeficiency virus (HIV)-related stigma and depression, suicidal ideation, and suicidal attempt among people living with HIV/Acquired immune deficiency syndrome (AIDS) (PLWH)
The current study examined the relationships among perceived and internalized stigma (PIS), depression, and suicidal status of people living with HIV/AIDS (PLWH) in Guangzhou, China
The results showed that PLWH suffered from relatively higher levels of PIS and some PLWH had perceptions of HIV-related discrimination and/or negative self-images of themselves with the majority (63.8%) of the participants having experienced a medium level of PIS and 13.9% a high level. 38.4% of the PLWH reported depressive symptoms
Summary
Previous studies have shown positive association between HIV-related stigma and depression, suicidal ideation, and suicidal attempt among people living with HIV/AIDS (PLWH). Few studies have examined the mechanisms among HIV-related stigma, depression, and suicidal status (suicidal ideation and/or suicidal attempt) in PLWH. The current study examined the relationships among perceived and internalized stigma (PIS), depression, and suicidal status among PLWH in Guangzhou, China using structural equation modeling. The life expectancy among PLWH has increased due to ART, many other challenges to health persist, including challenges such as opportunistic infections, syphilis, tuberculosis, and prevalent HIVrelated stigma [1, 2]. Since HIV/AIDS is characterized as a degenerative and unalterable illness, people may have fears (e.g., fear of the disease, contagion, and death) towards PLWH and such fears may lead to universal expression of stigma [5]. PLWH who view themselves as persons responsible for their own behaviors are likely to experience intensive shame and guilt towards themselves [6]
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